Peter Coates

The custodian model from the inside: how the governance is built, how a hospital buys it, and where the money goes.

Part of the OpenEyes Conference interview series, recorded on 16 September 2026 in Cardiff, UK.

Custodianship in Practice: Governance, Market Making and the Asset Lock

They know where improvements need to be made. They just need to be empowered, facilitated and supported to do that.

About Peter Coates

Peter Coates is the Managing Director of the Apperta Foundation CIC and a member of the OpenEyes Committee. The foundation acts as custodian for a number of digital health projects.

Interview summary

Peter Coates describes Apperta as a custodian: it holds a project, and facilitates the subject-matter experts and clinicians who build software to meet their own needs. The governing structure he puts first is the clinical design authority - clinicians from the specialty, responsible for the functional requirements of the product, working to design principles on standards and architecture rather than setting the technical detail. Alongside it sit clinical safety groups, responsible for the product being produced safely, and project management groups made up of the organisations implementing and extending the software, which he describes as practical help across organisations.

What that arrangement solves, in his account, is ownership. Clinicians gain a route to change and improve the product, which he says has been proven many times over, and are not shoehorned into a vendor product whose development budget has closed. He frames it as putting them in control of their own destiny.

His route to the model came from service improvement in other sectors. Redesigning a service and then digitally enabling it takes you only so far; the remaining gains come from letting the people who deliver a service own it. He describes a continuum of models - a cooperative, an employee-owned company, a community interest company - and says they chose the community interest company for a range of reasons. The two halves of the job are custodianship, meaning governance, standards and strategy, and facilitation, on the grounds that the deliverers and users of a service know it better than anyone and need only to be empowered and supported.

On the supply side he describes market making. Apperta employs no software developers and does not want to: it wants a mixed market of development and professional services companies, and has had to encourage them in. He is explicit that oversupply would leave participation financially unviable for those firms, and calls the approach a classic commissioning one - buying in all the services needed to make up the whole.

On the demand side, procurement is deliberately conventional. Apperta centres on the G-Cloud framework and makes sure its professional services partners are on it, so a hospital buys in the way it has always bought. There is no software licence to acquire; what is purchased is implementation and support for an asset under Apperta's custodianship. The customer contracts with a professional services partner and pays a subscription directly to Apperta, which keeps the custodian independent of both the suppliers and the users.

He describes that subscription as membership rather than a licence. It carries a seat on the clinical design authority, a place in the other groups, and access to the resources a regulated environment requires - he names the clinical safety report and the hazard log - on the grounds that implementing software in healthcare is more than the software. Membership also carries equity of access: anything one member has produced is available to every other, so a hospital that could not fund a feature still receives it. His question is why any NHS patient should not be treated by a system that is best in class.

On ownership, the foundation holds the copyright and the intellectual property on behalf of the community, and publishes OpenEyes under an open source licence. He distinguishes a community implementation, downloadable from a public repository and which he says is now classed as a digital public good, from an enterprise implementation put in by a professional services partner. Forking is possible and he allows it may suit other territories with different regulation or language, but says that where it has been tried the results were not successful, and that a fork takes on the whole of the cost, risk and liability.

His advice to anyone considering an open source approach to a clinical need is that a custodian is not optional, and that its form matters: a not-for-profit, so that contributors are not exploited commercially later. He describes Apperta's assets as held in an asset lock under UK company law - they cannot be sold, and can only pass to another not-for-profit custodian with a similar purpose. That, he says, is what lets people contribute ideas freely.

Asked what would be different without the model, he says OpenEyes would not exist - by his figures serving a million NHS patients a year across 130 sites and growing - and that clinicians in the specialty would be less well served, with worse outcomes, forced to buy what exists rather than build what they need. He adds that software built by a single organisation travels badly: it is built for how that organisation works, is difficult to implement elsewhere, and harder still to find anyone to support.

His wish is public funding directed into this model, and he is specific that he does not mean new money. He argues that perhaps one per cent of current spending, redirected, would return more than the remaining ninety-nine, and describes it as a side bet: if it does not work, one per cent is a margin of error in most state-funded environments.